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KUPI ~VfIt FIStI Pllillllb 6V Vv. ..o.lrY4 !L~<L r. . <br />._ •OD~ t!`AR`TAA7 L`An •TD 7!!1T 7 TrT9r11f T•111CC1r11U nvnllTn An ncn~R.n •i~r\.cv •aTrr\.. <br />.\ •r • v. - vu ^__. - vrrv.-v.. u..uW-v.. f .V •.~• Vn . ~I~H~• ,1lVYU .vu~.V1\ <br /> 1 <br />Thin appliutioa moat be filled out completely except for N14 and NiS: ~ , appliutloo vv~ill be wosidered incomplete -SEE <br />INSTRUCTIONS ON REVERSE SIDE. Mail completed appliueioa AP~ and filiaa foe to:~ <br />' <br />Colorado Dtepatriaent ojNsalilr <br />.iPCD-SS-BI <br />1300 Char! Creek Drive South <br />Denver, Colorado d0222-IS30 Tekphont: (303)692-31:J <br />I. Ptrmfr ro be luued ro: - <br />S erset Minin Com an ~ ' <br />2. MdUng Addrar: ; . CO <br />. ..: ~ State: <br />P.O. Box 535, Somerset + TJpCode: 81434 <br />3a. Agent jot Scrvin (See No. 3 on revrrseJ: • ... _ , <br />36. Federal Tax ldenr~catlonNumber: 84-1119556 .:. :- <br />4a. Central Nature of Burtnest: 4b. SIC Code: '• <br />Coal Minin ~ .. .. ..:.:..:......,.... ...:... <br />Sa. Atr Pollution Source Description: Sb. Days per year sourcti wlU <br />Two Coal Stockpile ~~•' •• ~ i optrarci '235" ""`'`': <br /> <br />6a. Source Locatron Addretr (Include Location MapJ: ' • '~ " ~ ~ - ... <br />6b. U7M Cooidlriatu n Im <br />Immediately North of the town of Somerset, CO ___._H',.;_'.__:_V <br />N rrr TFrYV rl 6rr. lM a,lslr. d rY~s em rwll rM r kwrla<) County: G ~ nni non ' ~ ~ ~ ~~ ~ ~'~ ~ '~ "~ <br />7. ESTIMATED COSTS: Air PgUutlon Cotslrol urei or Equipment `•""" <br />Ta. Sourer, Proarss Equipment or Proffer: 7b. ~ UaI Corr: S .. - ;~' <br /> <br />Cap. Cost S .. <br />Tc:" staring Cott: S +~ ... .. ..... <br />Sa. SCATUS ~ .. . <br />^ New AJr Pollution Source <br />® Modjllcarlon to Permrrred Source (Control Equipment added, provwt ¢rrange, eta): <br />^ 7Fansjtr of Ownerthlp - 7Yansjerred from: ,~ <br />^ Exrtring Source- nor permitted pndude Date of Source Start-upJ: <br />^ Orher• ' <br />Proffered Dotes jot Constrriction ro: PrgJegred Source Startup Date: <br />Bb. Bcgln: Bc. End: Bd. <br />9. Enclose duck to cbm APEN FIL/NG FEES. One APEN should be flied jot taah tmlttlgn polm~ <br />NOTE: Additional proeersing jeer mart also be paid prior to ~amlr lr#rumee. <br />L APENS ®STS.00 per ADEN ~ S 'r5 = <br />10. SIGNATURE OF LEGALLY AUTXOWlED PERSON (~(QI Verdor or ~ l la. Duce Signed: 11b. Telephone No.: <br />Equipment Manujaaurtr) / ~i,~ GuL <br />~/r.GTF~, r.- T ; <br />~303~925-5122 <br /> <br />u. type or rnnr name once opraat rare o~ person trgnmg uan rv. <br />~~:at.TC~ ~. ~V.ZrC:riT <br />13. Chrxk appropriate box if you want: <br />a. D COPY ojprclimrnary artalytls rnrulucrrd by DlvLsion <br />b. D To review a draft ojrhe pmnir prior ro trtuontt7 <br />till W.ielr •Otw Ir.alil wnil Y r.l.r rr.uM M+M rJ•. V blwr. <br />~eocv Use Only <br />14. DATE RECEIVED: <br />15. PERMIT NUMBER <br />